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Palliative Care, Hospice Improves End-of-Life Care Among Patients With Hematologic Malignancies

Jaime Rosenberg
Patients with hematologic malignancies often receive intensive care at the end of life (EOL), but new research has demonstrated that hospice services and palliative care are associated with significantly improved EOL care quality.
Patients with hematologic malignancies often receive intensive care at the end of life (EOL), but new research has demonstrated that hospice services and palliative care are associated with significantly improved EOL care quality. The research was presented as 2 study abstracts at the 60th American Society of Hematology Annual Meeting and Exposition. 

The first study1 assessed EOL quality measures in patients with hematologic malignancies before and after receiving a specialist palliative care service, with the researchers drawing on medical records of 351 adult patients who died of these malignancies between April 1, 2007, and March 31, 2007, at the Komaki City Hospital in Komaki, Japan.

The palliative care service began April 1, 2012, with half of these patients dying prior to the initiation of the service and half dying after. During the period, 69 (39%) received specialist palliative care consultation and 24 (14%) died in the palliative care unit after April 2012.

Following the implementation of the specialist palliative care service, the number of patients who received at least 1 act of intensive EOL care significantly decreased from 23 (72%) in 2007 to 19 (63%) in 2016. During the same period, cases of cardiopulmonary resuscitation in the last 30 days of life decreased from 4 (13%) to 0, intubations in the last 30 days decreased from 2 (6%) to 1 (3%), and platelet transfusions within 7 days before death decreased from 18 (56%) to 14 (47%).

Meanwhile, there were no significant decreases in intensive care unit (ICU) admissions in the last 30 days of life, chemotherapy use within the last 14 days of life, or red blood transfusions within 7 days before death during the period.

Improvements in EOL care quality were significant among patients with malignant lymphoma, in particular. However, the same was not seen in acute leukemia, and the researchers noted that EOL care is still suboptimal among these patients.

Similarly, another study2 used Medicare administrative claims among patients with hematologic malignancies who did or did not use hospice services to determine EOL quality measures, finding that those who used hospice services experienced less aggressive EOL care. The study included data on nearly 54,000 patients with hematologic malignancies who died between 2007 and 2011.

“Across the spectrum of hematologic malignancies, which vary in prognosis and clinical course, use of hospice services is associated with markedly improved measures of EOL care quality, as well as lower Medicare spending in the last month of life,” wrote the researchers.

The researchers observed that use of hospice services led to a 95% decrease in inpatient deaths, a 48% decrease in days spent in the hospital, a 44% decrease in the risk of ICU stay, a 47% decrease in use of chemotherapy, and a 38% decrease in mean Medicare spending at EOL. However, the researchers did note that only 47% of beneficiaries with hematologic malignancies used hospice services.

Reference:
1. Kihara R, Ishiguri Y, Ueda N, et al. Effect of specialist palliative care service on end-of-life care in patients with hematologic malignancies. Presented at: 60th American Society of Hematology Annual Meeting & Exposition; December 1, 2018; San Diego, CA. Abstract 2242.

2. Egan P, LeBlanc T, Olszewski A. End-of-life care quality care outcomes among Medicare beneficiaries with hematologic malignancies. Presented at: 60th American Society of Hematology Annual Meeting & Exposition; December 3, 2018; San Diego, CA. Abstract 829.


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